The Anti-Psychotic Myth Exposed?

Psychminded.com ^ | 4/2/08 | Adam James

[bdeaner]

Anti-psychotics are not effective long-term, shrink the brain and almost triple the risk of dying early, a London NHS psychiatrist and academic has written in a new book. Isn't it about time for a deep examination of the validity of such drugs asks Adam James?

.....

Christian was slouched in a chair in Bradford psychiatric unit. He was, seemingly, only half-conscious, half alive. He could hardly speak, let alone raise his head.

Christian had been diagnosed with schizophrenia. Two days before, in a haze of paranoia, he had punched a colleague of mine at a day centre. So Christian was sectioned and medicated, heavily, with neuroleptics. Most, on seeing Christian would have described him as being so whacked out he was a dribbling wreck. Treatment-advisory body, the National Institute of Health and Clinical Excellence (Nice) would say the neuroleptics had successfully “calmed” Christian, in preparation for treating the “underlying psychiatric condition”.

Neuroleptics – such as Clozapine, Olanzapine, Risperidone and Seroquel – are the “primary treatment” for psychosis, particularly schizophrenia. Indeed, 98-100 per cent of people diagnosed with schizophrenia inside our psychiatric units – and 90% living in the community – are on neuroleptics, also called anti-psychotics. “There is well established evidence for the efficacy of anti-psychotic drugs”, Nice told mental health professionals in its guidelines for the treatment of schizophrenia.

Nice claims a similar efficacy for the widely-prescribed SSRI anti-depressants in treating depression. Some researchers disagree. A recent widely-publicised meta-analysis asserted that SSRIs are no more clinically beneficial than placebo for mild and moderate depression. London NHS psychiatrist Joanna Moncrieff is one such dissenting researcher. But she has conducted a far wider examination of psychiatric drugs, and has endeavoured to expose the “myth” of anti-psychotics. She claims there is no sufficient evidence to support their long-term use and they cause brain damage, a fact which is being "fatally” overlooked. Plus, because of a cocktail of vicious side-effects, anti-psychotics almost triple a person’s risk of dying prematurely.

Moncrieff, also a senior lecturer at University College London, particularly strikes out at her own profession, psychiatry, claiming it is ignoring the negative evidence for anti-psychotics. In her book, The Myth of The Chemical Cure, Moncrieff argues the increasing prescribing of these drugs is unleashing an epidemic of drug-induced problems. She argues, effectively, that psychiatry is guilty of gross scientific misconduct.

Having scrutinised decades of clinical trials, Moncrieff's first point is that once variables such as placebo and drug withdrawal effects are accounted for, there is no concrete evidence for antipsychotic long-term effectiveness.Moncrieff’s interpretation of the relevant meta-analyses and trials is radically different to Nice which arrived at an opposite conclusion for antipsychotic effectiveness.

At the heart of dissent against psychiatry through the ages has been its use of drugs, particularly anti-psychotics, to treat distress. Do such drugs actually target any “psychiatric condition”. Or are they chemical control, a socially-useful reduction of the paranoid, deluded, distressed, bizarre and odd into semi-vegetative zombies? Historically, whatever dissenters thought has been largely ignored. So, it appears, have new studies which indicate anti-psychotics are not effective long-term. For example, a US study last year in the Journal of Nervous and Mental Disease reported that people diagnosed with schizophrenia and not taking anti-psychotics are more likely to recover than those on the drugs. The study was on 145 patients, and researchers reported that, after 15 years, 65 per cent of patients on anti-psychotics were psychotic, whereas only 28% of those not on medication were psychotic. An intriguing finding, surely? So what about the mainstream media headlines of “breakthrough in schizophrenia treatment”? Afterall, broadsheets react positively to the plethora of alleged genetic "breakthroughs" in schizophrenia, even when it comes to genetically-engineered schizophrenic mice. But there wasn't a squeak.

Interestingly, the researchers of the Journal of Nervous and Mental Disease paper hypothesised that it was patients with "inner strength”, “better self esteem” and “inner resources” who were more likely to recover long-term without neuroleptics. However, not one peer-reviewed study examining the necessary individual characteristics and support networks to live through psychosis without drugs has, in the last 48 years, appeared in The British Journal of Psychiatry, the publication that each month drops through the letter box of every psychiatrist in the land.

The “psychological factors” of, for example, inner strength, are, perhaps more the terrain for clinical psychologists. Such as Rufus May who was compulsory treated with anti-psychotics when diagnosed with schizophrenia as an 18-year-old.

May argues withdrawal effects of anti-psychotics often get wrongly interpreted as “relapse”. So, he has launched a website advising people how safely to come off psychiatric drugs. Many patients, like May (who perhaps had the required "inner strength”), have successfully come off anti-psychotics and gone on to recover. The irony is that they frequently have had to do it behind the backs of their psychiatrists, who fear relapse.

Moncrieff’s second point is that the psychiatric establishment, underpinned by the pharmaceutical industry, has glossed over studies showing that anti-psychotics cause extensive damage, the most startling being permanent brain atrophy (brain shrinkage) and tardive dyskinesia. As in other neurological conditions patients suffer involuntary, repetitive movements, mental impairment, memory loss and behaviour changes. Brain scans show that anti-psychotics cause atrophy within a year, alerts Moncrieff. She accuses her colleagues of risking creating an “epidemic of iatrogenic brain damage”. Moncrieff is a hard-nosed scientist, so she is respectfully reserved. But her carefully-chosen words are still alarming. "It is as if the psychiatric community can not bear to acknowledge its own published findings,” she writes.

How worrying it is, also, that the Healthcare Commission should report last year that almost 40 per cent of people with psychosis are on levels of anti-psychotics exceeding recommended limits. Such levels cause heart attacks. Indeed the National Patient Safety Agency claims heart failure from anti-psychotics is a likely cause for some of the 40 average annual “unexplained” deaths of patients on British mental health wards. Other effects of anti-psychotics include massive weight gain (metabolic impairment) and increased risk of diabetes. Two years ago, The British Journal of Psychiatry - Britain’s most respected psychiatry journal - published a study reporting that people on anti-psychotics were 2.5 times likely to die prematurely. The researchers warned there was an “urgent need” to investigate whether this was due to anti-psychotics. But so engrained is the medication culture in mental health that many psychiatrists regard that not medicating early with anti-psychotics amounts to negligence, Moncrieff notes.

Moncrieff does acknowledge there is evidence for the short-term effectiveness of anti-psychotics. But again Moncrieff asks psychiatry to be honest. Moncrieff points out that when anti-psychotics, such as chlorpromazine, were first used in the fifties they were called “major tranquillisers.” Why? Because that’s an accurate description of their effect, particularly short term. They sedate, numb, or tranquillise, the emotions, so reducing the anxiety of paranoia and delusions. Any person on anti-psychotics would verify this (Go to askapatient.com). So, in this respect, they are effective. Nowadays, however, these drugs are referred to as “anti-psychotics”. For Moncrieff, this is a wheeze because there’s no evidence that anti-psychotics act directly on the “symptoms” – paranoia, delusions, hallucinations – of those diagnosed with psychosis. There’s nothing anti-psychotic about anti-psychotics.

Embedded in Moncrieff’s thesis is that, unlike other medical conditions, there is no evidence that psychiatric illnesses, including schizophrenia, are caused by physical abnormalities. As clinical psychologist Mary Boyle penned it, schizophrenia is a "scientific delusion” which drugs can never cure.

The alternatives? Moncrieff - like her fellow psychiatrists in a group called the Critical Psychiatry Network - asks services to look seriously at non-drug approaches, such as the Soteria Network in America. She believes psychiatrists such as herself should no longer have unparalleled powers to forcibly detain and treat patients with anti-psychotics. Instead, they should be “pharmaceutical advisers” engaging in “democratic drug treatment” with patients. Psychiatrists should be involved in “shared decision-making” with patients, and would have to go to civil courts to argue their case for compulsory treatment. "Psychiatry would be a more modest enterprise” writes Moncrieff, “no longer claiming to be able to alter the underlying course of psychological disturbance, but thereby avoiding some of the damage associated with the untrammeled use of imaginary chemical cures.”

Mental health policy is, it appears, swinging away from a reliance on antidepressants. Surely a deep re-examination of the true validity of anti-psychotics is also due?

[pieceofthepuzzle]

Just using steroid-induced psychosis as an example, here are just a few of a ton of references about this one entity. There are many others.

1. Ingram, D. G. & Hagemann, T. M. Promethazine treatment of steroid-induced psychosis in a child(2003) Ann Pharmacother 37, 1036-1039.
2. Viswanathan, R. & Glickman, L. Clonazepam in the treatment of steroid-induced mania in a patient after renal transplantation(1989) N Engl J Med 320, 319-320.
3. Turner, P. Steroid-induced psychosis(1989) Lancet 2, 923.
4. Black, A. C. Biochemical mechanisms of steroid-induced psychosis(1982) N Y State J Med 82, 1024.

Although we clearly do not have a definitive answer to the mechanistic basis of many if not most mental diseases, we know with certainty that neural activity is rooted in a complex interplay between brain architecture, neurotransmitters, and a variety of related processes and factors. Why is it so difficult to accept that abnormalities in how these processes work or interact is at the basis of many severe psychiatric diseases? I'm not saying that brain chemistry abnormalities are the cause of all our failings, unhappiness, and poor judgment, but I do believe that there clearly are people who very unfortunately have abnormalities in brain chemistry and that this has a big effect on their mental health. Schizophrenics are on an extreme of that spectrum.

[Tidbit]

Can you name a single scientific study that has identified any abnormal brain chemistry with any identified psychosis or neurosis, and what the specific chemical imbalances are?

Here's one:

http://www.medscape.com/viewarticle/412177

The article first appeared in an October 2000 issue of the American Journal of Psychiatry.

You sound like Tom Cruise claiming there's no such thing as depression.

[bdeaner]

Again the side effects of these drugs are serious and your attempts to minimize them are tragic and misguided.

[Hank Kerchief]

Thanks for the link, but it says I have to log in to see it. Since I’d have to join something to see it, and I join nothing, you’ll have to either provide me a login name and password, or provide a copy of the content. I’d really like to see it.

It’s late for me, so I’ll not be here until the morning.

I’m not your enemy. I’m only interested in the truth.

Hank

[Tidbit]

These places kept relatively few patients -- no more than 250 at any single facility.

We have those places in the United States today. One of them is located at 1600 North Pennsylvania. Another is just down the road on East Capitol. I hear there's one in Cuba too, but unfortunately it's going to be closed. /s

[Tidbit]

Sorry about that. Here's a link to an open site. I don't think we're enemies, at least not until my Thorazine wears off. I was being tongue-in-cheek about Tom Cruise, sorta.

Evidence of Brain Chemistry Abnormalities in Bipolar Disorder

[bdeaner]

praecox dementia

By the way, your statement betrays a certain ignorance of the diagnostic issue on hand. The issue is one of drug treatment of PSYCHOSIS. Schizophrenia is only one of several mental disorders that include psychosis as a symptom. Bipolar Disorder, in its manic phase, often has psychotic features. There is a psychotic depression. There is psychosis secondary to drug use, including stimulants such as Ritalin and Adderal, not to mention anti-psychotic medication. Psychosis can be induced by a medical condition, such as a head injury or brain damage. There is brief psychotic episodes. Etc, etc.

The only disorder that has any historical link with the VERY outdated concept of dementia praecox is schizophrenia, and that description, from Kraplein, is of a particular kind of psychosis that is hebephrenic and progressively degenerative in nature -- unlike many other manifestations of symptoms in individuals diagnosed with schizoprenia, per DSM-IV criteria.

Do you claim to have any training in psychiatric diagnosis?

The problem we are faced with is that physicians seem to be FAR too quick to hand out the anti-psychotic medication, when a condition might be transiant, as in a brief psychotic episode, but dependency on anti-psychotics drugs can then set in, and within a few months, for those sensitive to its effects, it can do a lot of damage in a short amount of time -- the incidence of akithesia alone is remarkably high with the atypicals. And for what? Because someone had a brief psychotic break? That's shameful.

[bdeaner]

I didn’t realize that FR had become a Scientology haven.

I posted this article, and I am not a Scientologist. I have a doctorate in clinical psychology, and am a full time, tenured professor at a reputable university. Stop the ad hominem b.s. and stick to the facts. You can't discount the facts by aligning them with a crack-pot cult and still claim to be operating within the bounds of a reasoned argument. So bring it on.

Secondly, you have a misguided view of psychiatry history -- you've bought into the storyline of psychiatry and Big Pharma. There is another side of the story. You sound like one of those drug rep whores who work for Big Pharma. But let me set you straight.

Mental hospitals began to empty after 1955. New Jersey state hospitals, for example, held 15,000 patients then and only about 4000 today. This massive "decarceration" is widely credited to the success of the psychotropic drugs, but there is really no evidence for this. The rates of release from mental hospitals began to rise in the United States and England in the late 1940s and early 1950s, before the drugs were introduced. Prison release rates also began to rise shortly afterward. The trend toward decarceration in both kinds of institutions resulted from a recognition of the astronomical costs of the new hospitals and prisons that would be required without a reversal of the trend toward incarceration. The availability of drugs cannot explain the increased release rates in prisons, nor for the high release rates for patients with chronic brain syndromes who rarely were treated with drugs.

Let's look at the numbers, then. In 1955, there were 559,000 people in public mental hospitals, or 3.38 people per 1,000 population. In 2003, there were 5 .726 million people who received either an SSI or SSDI payment (or from both programs), and were either disabled by mental illness (SSDI statistics) or diagnosed as mentally ill (SSI statistics).' That is a disability rate of 19.69 people per 1,000 population, which is nearly six times what it was in 1955.

Those are the facts. The facts do not support the view that psychiatric medication caused the hospitals to empty. The patients just switched venues -- they became homeless, went to jail, or ended up in a group home somewhere with 24 hour supervision and a Thorazine shuffle.

[Lucius Cornelius Sulla]

I posted this article, and I am not a Scientologist.

I do not have your expertise, but the source of this article is a Scientology friendly website.

[bdeaner]

Broken hearted in Los Angeles...

God bless you, Polly, and your family, especially your son. Stories like yous keep me energized in my fight to alert people like you to the dangers of anti-psychotic medication, which continue to be minimized by psychiatry and the pharmaceutical industry. It's time for the lies to stop.

[bdeaner]

I do not have your expertise, but the source of this article is a Scientology friendly website.

Don't get mesmerized by the source of the article. Scientologist-friendly or not, the article is factually correct.

[Lucius Cornelius Sulla]

I have the same attitude towards Scientology on psychiatry as I do Muslims on religion or Communists on economics.

[bdeaner]

Evidence of Brain Chemistry Abnormalities in Bipolar Disorder

Your problem is that you're not reading the original research study. You rely upon some journalist to interpret the study -- who obviously doesn't know how to critically evaluate a study's validity.

First, the findings are correlational. Correlation does not imply causation. One of the first things you learn in an introductory stats class.. If you are implying a causal relationship between these brain differences and the symptoms of bipolar disorder, you've made an incorrect inference, and should study up on hypothetico-deductive logic.

Second, the sample size in this study is very small. Only 16 patients are compared to 16 non-patients. That's a woefully inadequate sample size for making any reasonable generalizations to the population of interest here.

But most importantly, and the huge gaping hole of a flaw in this study is this: ALL THE BIPOLAR PATIENTS WERE BEING MAINTAINED ON MOOD-STABILIZING DRUGS AND A BUNCH OF THEM WERE ON ANTI-PSYCHOTIC MEDICATION. Gee, do ya think that might account for the differences in their brain functions, in comparison to non-patient comparison who are NOT on these drugs? TALK ABOUT A HUGE FRIGGIN' CONFOUNDING VARIABLE!!! This is the most pointless study I've read in a long time. You can conclude NOTHING from this, and the study probably shouldn't have been published, because people like you are going around referencing it like it means something when it doesn't mean jack. Good lord.

See for yourself. Read the study, dude:

http://ajp.psychiatryonline.org/cgi/content/full/157/10/1619

[bdeaner]

I have the same attitude towards Scientology on psychiatry as I do Muslims on religion or Communists on economics.

The article was published in The Guardian, so it's legit. It stands up to a fact check, and I urge you to challenge it on this ground. It's not a Scientology fluff piece. I don't see any reference to Scientology anywhere on the site--but who knows. Still doesn't change the facts.

Second, hey I'm with you on communism, but maybe you should try not to be less proud of your bigotry toward Muslims. Last time I checked, my God told me to love my enemies. We Christians share a lineage with Islam that goes back to Abraham. And if you read Genesis, which I suggest you do, God blessed Ishmael and promised him a great nation -- the nation that became Islam. So, it's not so clear cut.

[Lucius Cornelius Sulla]

maybe you should try not to be less proud of your bigotry toward Muslims.

9/11 taught me all I need to know about Islam.

[Lucius Cornelius Sulla]

maybe you should try not to be less proud of your bigotry toward Muslims.

9/11 taught me all I need to know about Islam.

[bdeaner]

9/11 taught me all I need to know about Islam.

That's like saying the Spanish Inquisition taught you all you need to know about Christianity.

I suspect your psychology is not that different from the guys who rammed those planes into the towers on that day. It's ultimately about hate -- a willingness to de-humanize a whole class of people and to take pride in ignorance.

[bdeaner]

,b>Luke 6:27-36

[27] "But I tell you who hear me: Love your enemies, do good to those who hate you, [28] bless those who curse you, pray for those who mistreat you. [29] If someone strikes you on one cheek, turn to him the other also. If someone takes your cloak, do not stop him from taking your tunic. [30] Give to everyone who asks you, and if anyone takes what belongs to you, do not demand it back. [31] Do to others as you would have them do to you.

[32] "If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. [33] And if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. [34] And if you lend to those from whom you expect repayment, what credit is that to you? Even 'sinners' lend to 'sinners,' expecting to be repaid in full. [35] But love your enemies, do good to them, and lend to them without expecting to get anything back. Then your reward will be great, and you will be sons of the Most High, because he is kind to the ungrateful and wicked. [36] Be merciful, just as your Father is merciful.

[bdeaner]

The Arabs are descents of Ishmael, who is described in the Old Testament:

Ishmael, meaning God hears, was the son of Abraham and Hagar, the Egyptian maid of his wife Sarah. When Sarah had found herself not having children, she arranged to have a child with Abraham by Hagar acting as a surrogate mother (Genesis 16:1-4), even though God had specifically stated that a child (i.e. Isaac) would be born to Sarah in due time.

Ishmael was born at Mamre, when Abraham was 86, 11 years after Abraham's arrival in what would become the land of Israel (Genesis 16:3). He grew up to be a man of the desert wilderness, with a wild and hostile attitude toward people, exactly as God described him to his mother before he was born:

"Behold, you are with child, and shall bear a son; you shall call his name Ishmael; because The Lord has given heed to your affliction. He shall be a wild ass of a man, his hand against every man and every man's hand against him; and he shall dwell over against all his kinsmen." (Genesis 16:11-12 RSV).

When a feast was held to celebrate the weaning of Isaac, who was born 13 years later, Ishmael caused trouble by insulting and mocking his little brother (Genesis 21:8-9). After Sarah, who by then had come to dislike both Hagar and Ishmael, saw what he was doing, she said to Abraham "Cast out this slave woman with her son; for the son of this slave woman shall not be heir with my son Isaac." (Genesis 21:10 RSV)

Abraham opposed Sarah's demand - despite Ishmael's difficult personality, Abraham loved him and did not want to see him go. God however settled the matter:

"But God said to Abraham, "Be not displeased because of the lad and because of your slave woman; whatever Sarah says to you, do as she tells you, for through Isaac shall your descendants be named. And I will make a nation of the son of the slave woman also, because he is your offspring." (Genesis 21:12-13 RSV)

Hagar and Ishmael were sent away, but they were not abandoned. God appeared and spoke to Hagar, assuring her that He would watch over them and see them prosper (Genesis 21:17-19). "And God was with the lad, and he grew up; he lived in the wilderness, and became an expert with the bow. He lived in the wilderness of Paran; and his mother took a wife for him from the land of Egypt" (Genesis 21:20-21 RSV).

Interpretation: Islam is the result of Abraham's sin. He did not have faith in God, but was inpatient, and slept with Sarah's slave woman, fearing that Sara could not become pregnant, as the Lord predicted. We reap what we sow. Salvation history demands that we resolve things with Islam peacefully, or else we make God a liar, for He promised Islam a place at the table. What are we Christians to do with that little problem? Not an easy one, and it is all too convenient to hate Islam because then that gives the appearance of resolving the problem -- yet the problem remains -- and will remain, until the Lord works out His salvation History according to His plan. I have faith He will not lead us astray, if we have faith in Him.

Of course, this is completely unrelated to this thread and probably belongs in another forum, but nevertheless...there it is.

[Lucius Cornelius Sulla]

There are few, if any active Muslims willing to denounce the 9/11 attacks. On that day I pledged my life to doing what I could to exterminate all of those who took part in this attack, or gave their approval, even their silent approval. I still have a lot of murdering to do to accomplish this goal. If I ever finish I will get back to you.